Health Program Auditor IV, Department Of Health Services

Job Description and Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California's health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today!

Please see the Special Requirements section for simple and easy steps on how to apply for this state position.

About this Role:

Investigations Division (ID) conducts administrative and criminal investigations to address fraud, waste and abuse in Medi-Cal and other DHCS programs. Specific activities include fraud data analytics, Medi-Cal fraud Hotline and complaint intake, investigative audits, provider fraud investigations, and beneficiary fraud investigations.

With minimal supervision, the Health Program Auditor IV (HPA IV) independently conducts the most complex and difficult federal and state mandated health program audits. The HPA IV is a subject matter specialist and must have extensive knowledge of laws, rules, regulations, and audit procedures to provide expert testimony and justification. As a lead, the HPA IV must be able to revise scope of work based on risk assessments for fraud, waste, and abuse. The incumbent develops audit procedures and templates to be used by the branch, the division, and/or Department, as applicable. The HPA IV develops training programs and criteria as well as being an instructor and resource of other staff. The HPA IV must coordinate and work alongside other team members to develop the basis for successful fraud prosecutions. To assure the proper and efficient operation of the Medi-Cal program, the HPA IV uses advanced technical, accounting, and auditing skills to perform program integrity functions which include onsite reviews of Medi-Cal providers, evaluation of Medi-Cal claim data, business and financial documents. The HPA IV is expected to able to develop, modify, revise and implement audit procedures as necessary for the most difficult and complex audits to obtain accurate audit findings while following auditing standards. The incumbent plans the scope and procedure of audits, conducts verification audit procedures on provider documentation, and Medi-Cal claim data; corresponds and discusses audit findings with health program providers, management, oversight and investigative agencies. Overnight travel of up to 15% may be required.

Have questions and/or need assistance? Contact ..., we are here to help walk you through the state hiring process!

This position is subject to the Department's Conflict of Interest Code and requires annual filing of a Statement of Economic Interests (Form 700).

You will find additional information about the job in the Duty Statement.

Working Conditions

Please see the Telework Information section below for telework details.

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

• HEALTH PROGRAM AUDITOR IV, DEPARTMENT OF HEALTH SERVICES

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Job Code #:

JC-486086

Position #(s):

...-XXX

Working Title:

Health Program Auditor IV (Hybrid Option)

Classification:

HEALTH PROGRAM AUDITOR IV, DEPARTMENT OF HEALTH SERVICES

$6,752.00 - $8,876.00

New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

# of Positions:

Multiple

Work Location:

Sacramento County

Telework:

Hybrid

Job Type:

Permanent, Full Time

Department Information

DHCS is California's health care safety net, helping millions of low-income and disabled Californians each and every day. DHCS' purpose is to provide equitable access to quality health care leading to a healthy California for all.

DHCS is a dynamic organization with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians. DHCS is committed to addressing disparities within our organization and in our communities through efforts toward greater diversity, equity, and inclusion. This is accomplished, in part, by a commitment toward employing a diverse workforce that reflects the many communities we serve, and by promoting and enforcing equal employment opportunity.

Take a look at some of DHCS' recent projects and happenings that our department has accomplished in the DHCS Newsroom

Special Requirements

Simple Application Steps

If you are interested in this position, complete the following simple steps:

• Review the education and experience minimum qualifications (MQ's) of the Health Program Auditor IV. See the Minimum Requirements section above.
• Submit your application package with all required documents, see the "Required Application Package Documents" section below.

All current Health Program Auditor III who have taken the Health Program Auditor IV exam are encouraged to apply.

DHCS will review your application package and contact you after the job posting/final filing date.

Application Instructions

Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.

Final Filing Date: 8/7/2025

Who May Apply

Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply. Individuals who are eligible for a Training and Development assignment may also be considered for this position(s).

Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).

How To Apply

Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at www.CalCareers.ca.gov. When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below:

Address for Mailing Application Packages

You may submit your application and any applicable or required documents to:

Department of Health Care Services

Mailing

Attn: Certification Technician JC 458785

M.S. 1300

P.O. Box 997411

Sacramento, CA 95899-7411

Address for Drop-Off Application Packages

You may drop off your application and any applicable or required documents at:

Department of Health Care Services

Drop-Off

Certification Section JC 458785

1501 Capitol Avenue, Suite 71.1501

Sacramento, CA 95814

08:00 AM - 04:00 PM

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at www.CalCareers.ca.gov. All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is optional. It may be included, but is not required.

Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

This position requires the incumbent to have and maintain good rapport, consistent and regular attendance, communicate effectively both orally and in writing in dealing with the public and/or other employees. Please indicate your eligibility in the area of the application where you enter the position name and number for which you are applying.

Desirable skills include:

• Enthusiastic and self-motivated
• Good communication skills (both written and verbal)
• Strong work ethic and ability to persevere

Benefits

DHCS is dedicated to creating an innovative workplace for its team members that is inclusive, diverse, and interactive! Here are a few of the ways we stay engaged with our team:

• Continuous and ongoing training
• Diversity, Equity, and Inclusion program activities
• Employee Assistance Program (EAP)

Additionally, as a team member of the State of California, you may be eligible for many benefits, such as:

• Medical, including health, dental, and vision insurance.
• Paid Holidays and vacation/leave
• Defined retirement program
• Savings Plus Program (401(k), 457)
• Medical/Dependent Care Reimbursement Accounts

Full benefits information can be found on CalHR's California State Civil Service Employee Benefits Summary.

DHCS 2023-2027 Strategic Plan provides more information about our commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey: SurveyMonkey link. This survey is not required to be considered for this position

In addition, DHCS - Audits & Investigations offer:

• Training opportunities to support role
• Upward Mobility

Contact Information

The Hiring Unit Contact is available to answer questions regarding the position or application process.

Hiring Unit Contact:

Nicholas Manzanares

...

...

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact:

EEO Officer

...

...

California Relay Service: ... (TTY), ... (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

DHCS Telework Information

The DHCS standard for hybrid work is a minimum of two days per week in-person and site-based and up to three teleworking days per week in accordance with DHCS' Telework Program and Government Code sections 14200 - 14203. This position may be eligible for telework up to five days a week, contingent on operational business needs. The amount of telework is at the discretion of the Department and is subject to change. The selected candidate will be assigned an available DHCS office closest to their residence prior to their start date. The selected candidate will be required to report to their assigned DHCS office and other DHCS locations as needed. Business travel may be required, and reimbursement considers an employee's designated office and residence subject to regulations and bargaining unit contract provisions. All commute expenses to the reporting location will be the responsibility of the selected candidate. For a list of possible DHCS office assignment locations, please reference the reporting location document attached to the duty statement on this job advertisement.

Additional Information

Using the online application system as specified in the announcement is the preferred method of applying for civil service job opportunities; however, applicants may instead apply by way of U.S. mail, parcel delivery or courier service, or in person, as set forth in this announcement.

Paper applications must include a signature. Dates printed on envelopes by mobile barcodes or equivalent mobile print technology are not acceptable proof of the date the application and any other required documents or materials were filed.

Applicants must state their basis of eligibility (List Eligibility, Lateral Transfer, Reinstatement, T&D, or Surplus/SROA), and the Job Control (JC) number and/or position number in the "Examination(s) or Job Title(s), For Which You Are Applying" section on the STD. 678. Surplus/SROA candidates should submit a copy of their letter with their application. Please remove any confidential information (i.e., social security number, date of birth, etc.) as well as any information regarding your LEAP eligibility and/or exam scores from your documents prior to submission.

If applying electronically, please note that CalCareers no longer allows applicants to withdraw their applications. If you need assistance to withdraw your application, please contact the Recruitment Section at ... For all other questions regarding your CalCareer account, please contact CalHR's CalCareers Unit at ... or ...

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.